Eating well in pregnancy

Healthy eating during pregnancy is important to give your baby a healthy start. Important inclusions in your diet are: folic acid, iron, calcium, iodine and protein. Weight gain is a normal part of pregnancy and most women can expect to gain between 11 and 16kg.

Aim to lead a healthy lifestyle before becoming pregnant. This includes being active and maintaining or working towards a healthy weight.

It is best that you have a healthy, nutritious diet before becoming pregnant. This will help your nutrient stores to be ‘topped up’. You should try to include a wide variety of food from each of the food groups daily.

Weight gain is a normal part of pregnancy. How much weight you put on partly depends on your weight before pregnancy. Aim for a healthy amount of weight gain.

Pregnancy is not a safe time for trying to lose weight.

If you are underweight at the beginning of pregnancy or having twins you may need to gain a little more weight, or if you are very overweight you should gain a little less. Talk to your doctor about how much weight you could expect to gain in your pregnancy.

Most women of a healthy weight can expect to gain between 11 and 16kg.

A typical pattern of weight gain is

1-1½ kg in the first 3 months

1½-2 kg per month for the rest of the pregnancy

The weight gain is made up of extra body tissue, placenta, fluid and blood as well as your developing baby. If your weight gain is in the healthy range you can expect to return to your pre-pregnancy weight after your baby is born. Breastfeeding is a great way to help this happen. You will use up more energy breastfeeding than at any time during your pregnancy.

It is very important to have enough folic acid in your body in the early weeks of your pregnancy when the cells of your baby's brain and spinal cord are dividing. During these weeks you may not even know whether you are pregnant.

Green vegetables, wholegrain breads and cereals are good sources of folic acid.

However, it is difficult to get enough folic acid from food alone.

The easiest and most effective way is to try to include plenty of foods rich in folic acid, and take a 0.5mg folic acid tablet each day for at least one month before you get pregnant and for the first three months of pregnancy.

You need more iron during pregnancy. Iron is needed for making blood and carrying oxygen around the body. If you don't have enough iron you may develop anaemia. This may make you feel very tired and worn out.

Good sources of iron include - lean red meat, followed by pork, chicken and fish

Some plants have iron in them too, like wholegrain breads and cereals, legumes and green leafy vegetables.

Your body can absorb the iron in animal foods better than the iron in plant foods. To help your body absorb the iron in plant foods, eat them with foods high in vitamin C, like oranges, tomatoes and capsicum. For example have a glass of orange juice when you have your wholegrain breakfast cereal.

Your doctor or midwife will measure your iron levels during your pregnancy and check for anaemia. If you are low in iron they might suggest that you take an iron supplement (tablet) containing iron. Taking iron tablets during pregnancy is safe.

To find out more have a look at the topic Anaemia in pregnancy on the Pregnancy, birth and baby website. Pregnancy, Birth and Baby is a national Australian Government service providing support and information for expecting parents and parents of children, from birth to 5 years of age. http://www.pregnancybirthbaby.org.au/

Your body needs calcium during pregnancy to help your baby build strong healthy bones and teeth, help with blood clotting and to keep nerves and muscles working well. If you don't get enough calcium from your food the baby may take it from the stores in your bones. This could make your bones weaker later in life.

Dairy foods like milk, yoghurt and cheese, and fish with bones that you can eat (canned sardines or salmon) are the best sources of calcium. Aim to have at least 2-3 serves of these foods each day. Soy milk with added calcium is also a good source of calcium.

If it is difficult for you to get enough calcium from your diet you may need to take a calcium supplement (tablet). For more advice, talk with your doctor or midwife.

Iodine is an important mineral needed for a baby's brain and nervous system development during pregnancy and breastfeeding, but many pregnant women in Australia do not get enough iodine in their diet.

Extra iodine is needed in pregnancy, and it can be quite difficult to get enough iodine through food alone. Good food sources of iodine include bread, dairy foods, eggs, iodised salt, canned salmon and seaweed. If you are not consuming bread, fish and 3 serves of dairy most days it is unlikely you are getting enough iodine.

Ocean fish and seaweed are the best sources of iodine, while meat, eggs and dairy foods are good sources but contain smaller amounts. 'Iodised salt' is regular table salt that has iodine added. This is a good source of iodine, but people should use salt in moderation.

In 2009, it became a legal requirement in Australia that all salt used to make bread, except organic bread, be replaced with iodised salt. The Australian Government has used iodised salt in bread to help Australians get more iodine in their diet.

To increase your iodine intake:

choose 2-3 serves of ocean fish each week (but some types of fish should be limited in pregnancy – see 'Mercury in fish' below)

include meat, eggs and dairy food in your diet each day, and

any salt used in cooking or on foods should be 'iodised salt',

The National Health and Medical Research Council (NHMRC) have released a recommendation that all women in Australia who are pregnant, breastfeeding or considering pregnancy take an iodine supplement of 150μg each day. Speak to your doctor about taking an iodine supplement. Many pregnancy multivitamin and mineral supplements contain iodine.

Your body needs a little extra protein during pregnancy for your growing baby. Foods high in iron and calcium are also good sources of protein. If you eat extra amounts of these foods you should already be getting enough protein.

FluidsDuring pregnancy it is important to drink enough fluid. Aim for about 2 litres of fluid a day. Water is the best choice. Only have small amounts of fruit and vegetable juices, soft drinks and cordials.

Alcohol

The safest choice for a healthy pregnancy is to drink no alcohol.

It is not clear how much alcohol, if any, is safe to drink during pregnancy. The more you drink the greater the risk to your unborn baby. Binge or heavy drinking throughout pregnancy is especially harmful.

CaffeineIt's best to limit the amount of caffeine-containing drinks you have during pregnancy. Drinks that contain caffeine include coffee, tea, cola drinks and some other soft drinks, including 'energy' drinks.

Too much caffeine can make you irritable and nervous, and make it difficult for you to go to sleep. High levels may make miscarriage more likely. In humans, even large amounts of caffeine do not appear to cause an increased risk of birth defects.

If you are vegetarian make sure you choose a variety of protein foods such as dairy foods, legumes, cereals/ grains and nuts/seeds.

If you choose to follow a vegan diet you should take extra care to include a variety of protein foods over the day.

Some ideas are:

Pasta with a lentil sauce

Falafel – legumes and tahini

Baked beans on toast

Peanut butter on wholegrain bread

Soy drinks with added calcium are very useful for vegans to help meet their requirements for calcium.

Vegetarian sources of iron include wholegrain breads and cereals, legumes and nuts, green leafy vegetables and eggs. Eating or drinking a vitamin C rich food e.g. fruit or juice at the same meal will help the absorption of iron from these foods. Cheese should not be used as a regular meat replacement as it is low in iron. For both lacto-ovo and vegan vegetarians, it can be very difficult to meet your iron needs in pregnancy, and an iron supplement may be needed.

A strict vegan diet can be low in vitamin B12 and some fatty acids. Vitamin B12 and fats are important for the normal development of the brain, eyes, spinal cord and nervous system of your baby. If you are a vegan vegetarian and pregnant or breastfeeding you should look to include foods fortified with vitamin B12 and fatty acids, take a supplement, or consider including some milk, egg or fish in your diet during this time.

Whether you are vegetarian or vegan, you should ensure you are getting enough energy from your food to meet the extra demands of pregnancy. A good way to check this is to make sure you are gaining enough weight.

Vegetarians who are pregnant may benefit from seeing a dietitian to ensure they are getting enough iron, zinc, calcium, vitamin B12, fats and good quality protein to meet their needs.

Listeriosis is a rare but serious illness caused by a germ called Listeria. Listeria can be passed on by contaminated food or poor food hygiene. It causes few or no symptoms to the mother, however the infection may be transferred to the baby and can lead to miscarriage, stillbirth or premature labour, or it can make a newborn baby very ill.

You can reduce the risk of Listeriosis by taking simple food hygiene steps at home, avoiding certain high risk foods and being careful about food prepared by others.

Toxoplasmosis is an infection which usually does not cause any illness in humans, however, if a pregnant woman gets toxoplasmosis it may also affect her unborn child. For more information have a look at the topic 'Toxoplasmosis'.

It is recommended you eat fish as part of a healthy diet during pregnancy as it offers many benefits to both yourself and the growth and development of your baby. However, deep fried fish is high in fat and should be eaten only sometimes.

Mercury, a naturally occurring heavy metal found in our environment, can build up in some types of fish. Pregnant women need to be careful of the types and amounts of fish they eat as their baby is more at risk to the effects of mercury.

Following these guidelines will ensure that yourself and your baby do not get too much mercury.

If you are pregnant or planning a pregnancy, you can eat up to:

2 –3 serves of any fish or seafood per week not listed below

OR

1 serve of sea perch/orange roughy or catfish per week and no other fish consumed that week

OR

1 serve per fortnight of shark (flake) or swordfish/broadbill/marlin and no other fish consumed that fortnight.

Canned tuna generally has lower levels of mercury than other tuna. It is therefore safe for all population groups to consume a small can of tuna (95 grams) everyday, assuming no other fish is eaten. Canned salmon or sardines are also good alternatives. But remember, the Australian Dietary Guidelines recommends that a variety of foods be eaten.

It is common to have cravings for certain foods during pregnancy. Try not to let these cravings stop you from eating a good variety of healthy foods. Cravings don’t indicate that you are not eating enough of a certain food or nutrient.

Some women crave sweet foods while others want more salty snacks, spicy or fatty foods or foods that they would not normally eat. Sometimes the craving may be for much more meat than usual - even for vegetarians. The cravings are real but it is not clear why they happen.

Some women find that they really want to eat things that are not food - but this might be harmful for their own health and that of their baby. This is called pica - there is more about pica in the cyh.com topic 'Eating things that are not food'. Some women who eat things that are not food are found to have low levels of iron in their body which might be the trigger for the craving. Sometimes the things that she might want to eat have high lead levels and might cause lead poisoning.

Between 50 and 80 per cent of pregnant women also find that they want to avoid some foods they previously enjoyed - they may find that the smell of some foods becomes unbearable.

If a you want particular foods it is usually OK to eat some of that food, as long as it doesn't become your main food replacing more important foods.